I received one of those politely worded letters from a major insurance company recently informing me of how it thought I was doing caring for one of my patients. It includes warm language such as “We value our relationship with you,” though their medical director who signed this letter has never made an effort to develop a personal relationship with me. The letter goes on to say “[This company] continuously seeks ways to support your efforts to provide the best possible care for your patients.” Best I can figure out, this company must have been hired to perform a chronic disease oversight function by Medicaid, which is this patient’s coverage.
These letters are typically worded claiming that the insurance company is on my side to help me close care “gaps” for my patient with diabetes. The company bases its Big Brother feedback on its electronic claims data, which this letter claims has “… extensive data assets and analytic capabilities, we are able to provide you with data that can give you important patient-specific information.” There are at least three problems with this letter and the company’s attitude.
The first problem is this patient just started to come to our clinic within the last two months. He may have just qualified for Medicaid or perhaps he recently transferred his care to our clinic from another physician. The insurance company’s computers are no help to me seeking out information outside my own clinic walls. (Also, I’ve never actually seen this patient, two of my colleagues did. My name must have been assigned to him on his Medicaid card.) The company’s assumption that two months is enough time to address all relevant chronic disease concerns is absurd. Chronic disease care is always a collaboration with patients, who often don’t want to do things their physicians would like them to do. Sometimes it takes multiple visits to get patients caught up with recommended treatment, if ever in some cases.
The second problem is that this letter makes it clear I’m supposed to take my time searching out his records to answer their letter. I dislike unfunded mandates. Insurance companies and health benefit consultants have convinced employers that disease management companies should be paid for “care oversight,” but they’re not willing to pay me an extra dime for my time to deal with their paperwork. And don’t think my nurses have time do this. They work their butts off as well and aren’t sitting around looking for something to do.
I went ahead and looked up his information. Here are the four “Health Opportunities” this company identified:
“… [your patient] may not have had two A1C lab tests in the past year.” He just started coming to our clinic.
“… [your patient] may not have had an LDL lab test in the past year.” We ordered one the first time we saw him and it’s fine.
“… [your patient] may not have had a triglyceride test in the past year.” We ordered one the first time we saw him and it’s fine (it’s part of the same cholesterol panel the LDL is part of).
“Our records suggest that your patient may have a history of diabetes and may not have had a screening for diabetic retinopathy in the past year.” I can’t comment as specifically on this issue (I’m writing this without his paper chart in front of me). This retina screening service doesn’t appear in our electronic record summary. I don’t know if this test was ordered but the patient either hasn’t had an appointment yet, or one was made and he never showed up, or if he had one recently with an eye doctor outside our system. Their “extensive data assets and analytic capabilities” are not powerful enough to actually help me check his eye screening status in outside facilities.
The third problem is that the letter portrayed these tests as “cost-saving opportunities.” This statement shows a profound ignorance of basic medical economic realities. Testing and treating high cholesterol (LDL) doesn’t save money and is extraordinarily expensive for low-risk patients. There is no evidence treating isolated high triglycerides improves any outcomes patients care about. Screening for diabetic retinopathy (eye disease) doesn’t save money and is extraordinarily expensive for low-risk patients. There is no evidence any specific scheduled pattern of A1C testing saves money, nor does adding more medicines to lower A1C levels save money.
This letter was signed by the national medical director for this insurance company. I wonder if he’s really ignorant of medical-economic realities, or if he just sold his soul to his employer and those who hired it (large corporations and/or Medicaid plan administrators), and he would rather sign an erroneous letter than confront his masters with difficult truths.
This company put little thought and effort into this silly attempt to improve quality of care, but this useless letter allows them to go back to the companies that hired the insurance company with the box checked that they provided chronic disease management. This is a prime example of the excessive and wasteful administrative overhead of U.S. healthcare. I will not waste another minute of my valuable time filling out their form and mailing it back to them. I will give it the attention it deserves by tossing it in the shredder box.